Social determinants of childhood asthma symptoms: an ecological study in urban Latin America.

Asthma is an important public health problem in urban Latin America. This study aimed to analyze the role of socioeconomic and environmental factors as potential determinants of asthma symptoms prevalence in children from Latin American (LA) urban centers. We selected 31 LA urban centers with complete data, and an ecological analysis was performed. According to our theoretical framework, the explanatory variables were classified in three levels: distal, intermediate, and proximate. The association between variables in the three levels and prevalence of asthma symptoms was examined by bivariate and multivariate linear regression analysis weighed by sample size. In a second stage, we fitted several linear regression models introducing sequentially the variables according to the predefined hierarchy. In the final hierarchical model Gini Index, crowding, sanitation, variation in infant mortality rates and homicide rates, explained great part of the variance in asthma prevalence between centers (R(2) = 75.0 %). We found a strong association between socioeconomic and environmental variables and prevalence of asthma symptoms in LA urban children, and according to our hierarchical framework and the results found we suggest that social inequalities (measured by the Gini Index) is a central determinant to explain high prevalence of asthma in LA.

Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities.

BACKGROUND: In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US$70 per person a month) when they comply with conditions related to health and education. Transfers range from $18 to $175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections. METHODS: The study had a mixed ecological design. It covered the period from 2004-09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0-17·1%), intermediate (17·2-32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme). FINDINGS: Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92-0·96) for intermediate coverage, 0·88 (0·85-0·91) for high coverage, and 0·83 (0·79-0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24-0·50) and diarrhoea (0·47; 0·37-0·61). INTERPRETATION: A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil. FUNDING: National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.

[Childbirth and live newborns of adolescent and young adult mothers in the municipality of Feira de Santana, Bahia State, Brazil, 1998]. / Estudo dos partos e nascidos vivos de mães adolescentes e adultas jovens no Município de Feira de Santana, Bahia, Brasil, 1998.

Data from the Brazilian Ministry of Health and the literature indicate that adolescents may be overrepresented in the prevalence of maternal morbidity and mortality and neonatal complications. This study focused on childbirth and live newborns among adolescent and young adult mothers in the municipality of Feira de Santana, Bahia, identifying risk factors for morbidity and mortality. A cross-sectional cohort study was conducted based on data from the Information System on Live Births (SINASC) in the municipality in 1998, totaling 5,279 live births among adolescent (10 to 19 years) and young adult mothers (20 to 24 years). Variables were age, schooling, prenatal care, gestational care, form of delivery, and birthweight. The authors measured the association between maternal age and the child's birthweight, while controlling potential confounders. Some 21.6% of live births were to adolescent mothers, 51.2% of whom had not finished primary school; there was an association between the 10 to 16-year age bracket and incomplete primary schooling, lack of prenatal care, and low and insufficient birthweight as compared to the other age brackets; there was also a high rate of underrecording in the SINASC. The results suggest the need for specific measures focusing on the reproductive health of adolescents in the municipality.

Estudo dos partos e nascidos vivos de mães adolescentes e adultas jovens no Município de Feira de Santana, Bahia, Brasil, 1998 / Childbirth and live newborns of adolescent and young adult mothers in the municipality of Feira de Santana, Bahia State, Brazil, 1998

Data from the Brazilian Ministry of Health and the literature indicate that adolescents may be overrepresented in the prevalence of maternal morbidity and mortality and neonatal complications. This study focused on childbirth and live newborns among adolescent and young adult mothers in the municipality of Feira de Santana, Bahia, identifying risk factors for morbidity and mortality. A cross-sectional cohort study was conducted based on data from the Information System on Live Births (SINASC) in the municipality in 1998, totaling 5,279 live births among adolescent (10 to 19 years) and young adult mothers (20 to 24 years). Variables were age, schooling, prenatal care, gestational care, form of delivery, and birthweight. The authors measured the association between maternal age and the child's birthweight, while controlling potential confounders. Some 21.6 of live births were to adolescent mothers, 51.2 of whom had not finished primary school; there was an association between the 10 to 16-year age bracket and incomplete primary schooling, lack of prenatal care, and low and insufficient birthweight as compared to the other age brackets; there was also a high rate of underrecording in the SINASC. The results suggest the need for specific measures focusing on the reproductive health of adolescents in the municipality.

Indicadores materno-infantis na adolescência e juventude: sociodemográfico, pré-natal, parto e nascido-vivos / Maternal-infantile indicators in adolescence and youth: socio-demographic, prenatal, delivery and newborns

Objetivo: conhecer características e associações entre idade materna e aspectos da gestação, parto e nascidos vivos de adolescentes e adultas jovens em Feira de Santana, Bahia. Métodos: estudo epidemiólogico de corte transversal com nascidos vivos e mães adolescentes (10-16-19 anos) e adultas jovens (20-24 anos), através de Informações de Nascidos Vivos (SINASC-1998), totalizando 5.279 nascimentos. As variáveis foram classificados em sociodemográficas (idade, escolaridade e sexo do recém-nascido) e relacionadas a gestação, parto e condições dos recém-nascidos. Os dados processados usando a razão de prevelência e a análise multivariada. A regressão logística foi usada para controlar fatores de confusão (pré-natal e idade gestacional) e associar idade materna e peso de nascimento. Resultados: em 1998, 21,6 por cento dos nascidos vivos no município foram de adolescentes; a escolaridade de 51,2 por cento das mães era 1§ grau incompleto; e a razão de risco ajustada apontaram maior prevalência de analfabetismo, não realização do pré-natal, peso insuficiente ao nascer e menor prevalência de peso adequado, na faixa de 10 a 16 anos, comparada às demais faixas estudadas. A agressão logística mostrou associação positiva entre idade materna e peso insuficiente, bem como associação negativa com peso adequado ao nascer. Verificou-se significativa falta de registros em alguns itens do SINASC. Conclusões: o resultados apontaram entre adolescentes alta prevalência de nascidos vivos e baixo nível de escolaridade, além do risco aumentado para analfabetismo, não realização de pré-natal, baixo peso e peso insuficiente do RN, principalmente na faixa de 10 a 16 anos, em comparação com as outras faixas estudadas

Condiþ÷es de gestaþõo, parto e nascimento em adolescentes e adultas jovens: Santa Casa / Condiciones de gestación, parto y nacimiento en adolescentes y jovenes adultas: Santa Casa / Conditions of gestation: childbirth and birth in adult adolescents and young

En este estudio, las diferencias estadisticamente significativas ocurrieron en relación a los aspectos sociales demográficos, de la sexualidad y comportamiento frente a la inserción en el prenatal. Del punto de vista obstétrico y datos de los RN no fueron verificadas diferentes estadísticas

Condiçöes de gestaçäo, parto e nascimento em adolescentes e adultas jovens: Santa Casa / Condiciones de gestación, parto y nacimiento en adolescentes y jovenes adultas: Santa Casa / Conditions of gestation: childbirth and birth in adult adolescents and young

En este estudio, las diferencias estadisticamente significativas ocurrieron en relación a los aspectos sociales demográficos, de la sexualidad y comportamiento frente a la inserción en el prenatal. Del punto de vista obstétrico y datos de los RN no fueron verificadas diferentes estadísticas